Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301009810 | MI |
N | 111NP0017X | Pediatric Chiropractor | 2301009810 | MI |
N | 111NR0400X | Rehabilitation Chiropractor | 2301009810 | MI |
NPI | 1124318183 |
---|---|
Provider Name | Dr. Erik Kowalke |
First Address | Wyoming, MI 49418-9300 |
Second Address | Wyoming, MI 49509-9542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 23/05/2011 |